For a small, symptomatic goiter, doctors typically treat with thyroid hormone replacement drugs. The drugs can slow down or stop the growth of the goiter in some cases, but they don’t typically shrink the goiter.
If the goiter is large, continues to grow while on thyroid hormone, is cosmetically unsightly, or symptoms continue or worsen, doctors may recommend radioactive iodine (RAI) to shrink the gland, or surgery to remove it all or in part.
In some cases, goiter can be due to iodine deficiency, in which case, doctors may recommend use of iodine supplementation.
THYROID NODULESNodules can be malignant (cancerous), benign, or indeterminate. The screening process, which involves blood tests, imaging tests, and typically, fine needle aspiration (FNA) biopsy helps to identify whether a nodule is cancerous. When the biopsy is indeterminate, many patients choose to get a second opinion on thyroid nodules.
The thyroid is almost always surgically removed all or in part when cancerous nodules are detected. In the case of malignancy, thyroid cancer treatment protocols are followed, based on the type of cancer detected.
In the past, thyroidectomy was performed after a fine needle aspiration (FNA) showed indeterminate or inconclusive nodules, but a new process, Veracyte Afirma Thyroid Analysis, eliminates these indeterminate results and prevents unnecessary surgery.
For small, benign nodules that cause no symptoms, many practitioners prefer to monitor patients. A substantial percentage of the population – some experts suggest the majority of people – have these asymptomatic nodules, and require no further treatment.
For symptomatic benign nodules, the first course of treatment is frequently the thyroid hormone replacement drug levothyroxine, which can sometimes shrink the nodule, prevent nodules from growing, and help prevent more nodules from forming. Because the treatment is fully effective in only a minority of patients, levothyroxine therapy is considered somewhat controversial.
If the benign nodule is larger and unresponsive to drug or radioactive iodine treatment, surgery is often recommended.
Another approach being used for nodules is Percutaneous Ethanol Injection (PEI), where the nodule is shrunk by an injection.
Another promising new non-surgical technology for nodules is high-intensity ultrasound beam technology.
Detailed guidelines on treatment for nodules are featured in the American Association of Clinical Endocrinologists’ Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules.
THYROID CANCERThere are four different types of thyroid cancer: papillary, follicular, medullary, and anaplastic. The treatments are based on the type of cancer, and in some cases, the staging -- how far the cancer has spread to other parts of the body -- as well as if it’s a new cancer or a recurrent cancer.
The treatments for thyroid cancer include:
Surgery to remove the cancer, known as a thyroidectomy. Some patients receive a lobectomy, which removes only one side of the thyroid. A near-total thyroidectomy removes almost all of the gland. The entire thyroid is removed in a total thyroidectomy. Lymph node dissection is also sometimes performed during thyroid surgery, to assess the spread of thyroid cancer.
- Radiation therapy to kill cancer cells. Radiation can be delivered outside the body (known as external beam radiation) or by radioactive iodine (RAI), which is usually administered as a liquid or pill. The thyroid absorbs iodine, and the radioactive form of iodine collects in thyroid tissue and kills cancer cells.
- Hormone therapy, using thyroid hormone replacement drugs. Administering thyroid hormone, usually at suppressive doses to keep TSH low or undetectable, helps prevent thyroid cancer from recurring, by suppressing the activity of any residual thyroid tissue.
- Chemotherapy, which uses drugs to kill cancer cells. It may be taken in pill form, or intravenously.
Treatment for medullary thyroid cancer typically includes total thyroidectomy, and in some cases, lymph nodes are also removed. In the later stages of medullary thyroid cancer, radiation therapy to shrink tumors is used to help relieve symptoms and improve quality of life. In late stage medullary cancer, chemotherapy may be recommended to help relieve symptoms.
Treatment for anaplastic thyroid cancer can include the following: tracheostomy surgery to create an opening in the windpipe (done for tumors that interfere with breathing); total thyroidectomy to reduce symptoms; external-beam radiation therapy; chemotherapy; and clinical trials studying new therapies.
Some new therapies for thyroid cancer are currently in investigational or trial status, including the drug axitinib, combretastatin, and lenalidomide.
Detailed guidelines on treatment of thyroid cancer are featured in the Thyroid Cancer Guidelines from the American Thyroid Association (2006) (PDF).
Mary Shomon, About.com's Thyroid Guide since 1997, is a nationally-known patient advocate and best-selling author of 10 books on health, including "The Thyroid Hormone Breakthrough: Overcoming Sexual and Hormonal Problems at Every Age," "The Thyroid Diet: Manage Your Metabolism for Lasting Weight Loss," "Living Well With Hypothyroidism: What Your Doctor Doesn't Tell You...That You Need to Know," "Living Well With Graves' Disease and Hyperthyroidism," "Living Well With Autoimmune Disease," "Living Well With Chronic Fatigue Syndrome and Fibromyalgia" and "The Thyroid Guide to Hair Loss." Click here for more information on Mary Shomon.